Association of exclusive breastfeeding duration with consumption of ultra-processed foods, fruit and vegetables in Brazilian children.

BACKGROUND: There has been little evidence of the influence of breastfeeding on childhood eating habits. AIM: To evaluate the association between duration of exclusive breastfeeding (EB) and consumption of ultra-processed foods, fruits and vegetables by Brazilian children. METHODS: This is a cross-sectional study nested in a cohort of 403 children age 4-7 years. Food consumption was evaluated by three food records and the foods were grouped by the amount of processing involved (minimal, including fruit and vegetables to ultra-processed foods). Adjusted linear and multinomial regression models were proposed to evaluate the association of EB with children's food intake. Median duration of EB was 4.0 (2.0-6.0) months and the prevalence of EB of 4 months or more was 60.9%. RESULTS: Mean energy consumption was 1536 kcal/day, 38% of energy was from ultra-processed foods. Mean intake of fruit and vegetables was 130 g/day. For each 1-month increase in duration of EB there was a 0.7% decrease in energy from ultra-processed foods (ß: - 0.7; 95% CI: - 1.3 to 0.1; p = 0.038). EB of less than 4 months was associated with the child being in the lowest tercile for consumption of fruit and vegetables (Adjusted OR: 1.8; 95% CI: 1.1-3.0; p = 0.030) and the highest for consumption of ultra-processed foods (adjusted OR: 1.7; 95% CI: 1.1-2.9; p = 0.040). CONCLUSIONS: In addition to other benefits of EB, we emphasize its importance for the formation of healthy eating habits, contributing to a higher consumption of fruit and vegetables and lower consumption of ultra-processed foods in childhood.

Waist circumference, waist-to-height ratio and conicity index to evaluate android fat excess in Brazilian children.

OBJECTIVE: To evaluate the ability of anthropometric measurements to identify excess android fat and to propose cut-off points for excess central adiposity in children, according to age and sex. DESIGN: A cross-sectional study with children from a municipality of Minas Gerais, Brazil. Receiver-operating characteristic curve analyses were performed to evaluate waist circumference (WC), waist-to-height ratio (WHtR) and conicity index (C-index) in estimating excess android fat by dual energy X-ray absorptiometry (DXA). SETTING: Viçosa, Minas Gerais, Brazil. SUBJECTS: Children aged 4-9 years (n 788). RESULTS: Overweight prevalence was 29·1 % and android fat percentage was higher among girls. All central fat measurements were able to discriminate excess android fat in the age groups evaluated, especially WC and WHtR, with cut-off points showing good sensitivity and specificity overall. CONCLUSIONS: Because these methods are easy to obtain and inexpensive, it is possible to use WC, WHtR and C-index in population surveys to evaluate central obesity. The proposed cut-off points showed satisfactory values of sensitivity and specificity and can be used in epidemiological studies.

[Factors associated with dietary patterns in the second half of life]. / Fatores associados aos padrões alimentares no segundo semestre de vida.

The aim of this paper is to identify eating patterns of children aged 6, 9 and 12 months and their association with socioeconomic, behavioral, birth and nutrition variables. Cross-sectional study with children from a cohort in Viçosa-MG, with 112 children at 6 months, 149 at 9 months and 117 at 12 months. Food intake was assessed by a 24-hour recall and patterns extracted by cluster analysis. Breast milk was identified in at least one dietary pattern every month. There was a low participation of ultra-processed foods in the identified dietary patterns. At month 6, children with lower family income were less likely to belong to the dietary pattern composed of milk formulas. Already overweight/obesity was 3.69 times higher in children who made up the pattern 2 (dairy formulas, vegetables, vegetables, beef and pear). At 12 months height deficit (PR = 3.28) and bottle use (PR = 4.51) were associated with the dietary pattern composed of milk formulas and cow's milk. The dietary patterns identified reflected the important participation of breast milk in children's diets. Dietary patterns with the presence of other types of milk were associated with nutritional deviations and bottle feeding.

O objetivo deste artigo é identificar padrões alimentares de crianças com 6, 9 e 12 meses e sua associação com variáveis socioeconômicas, comportamentais, de nascimento e nutrição. Estudo transversal com crianças de uma coorte em Viçosa-MG, sendo 112 crianças com 6 meses, 149 com 9 meses e 117 com 12 meses. O consumo alimentar foi avaliado por um recordatório de 24 horas e os padrões extraídos por análise de agrupamentos. O leite materno foi identificado em pelo menos um padrão alimentar em todos os meses. Houve baixa participação de alimentos ultraprocessados nos padrões alimentares identificados. No 6º mês, crianças com menor renda familiar tiveram menos chance de pertencer ao padrão alimentar composto por fórmulas lácteas. Já o sobrepeso/obesidade foi 3,69 vezes maior em crianças que compunham o padrão 2 (fórmulas lácteas, verduras, legumes, carne bovina e pera). Aos 12 meses o déficit de estatura (RP = 3,28) e o uso de mamadeira (RP = 4,51) estiveram associados ao padrão alimentar composto por fórmulas lácteas e leite de vaca. Os padrões alimentares identificados refletiram a importante participação do leite materno na alimentação das crianças. Padrões alimentares com a presença de outros tipos de leite, foram associados a desvios nutricionais e uso de mamadeiras.

Relationship between breastfeeding patterns and intake of vitamin A and iron in children 6-12 months. / Relação entre os tipos de aleitamento materno e o consumo de vitamina A e ferro em crianças de 6 a 12 meses.

The aim of this study was to analyze the association between breastfeeding type in the first six months of life and intake of vitamin A and iron in children 6-12 months of age. It is a cohort study with 226 children. The type of breastfeeding from 1-6 months of life and the food intake from 6 to 12 months were evaluated. Nutrient intake between groups was compared by the Kruskal-Wallis test. The association between nutrient intake and type of breastfeeding was analyzed by Poisson Regression. Consumption below the recommendation of vitamin A and iron was 33.6% and 67.7%, respectively. Infants exclusively and predominantly breastfed from birth to two months had higher vitamin A intake from 6-12 months of life. Infants who were breastfeeding at 6 months had higher vitamin A intake and lower iron by the bivariate analysis. The group that received mixed feeding and artificial feeding at 1 month and the group non-breastfed at 6 months had vitamin A intake below the recommended from 6-12 month of life. The results reinforce the importance of exclusive breastfeeding in the first six months of life contributing to the higher vitamin A intake. Iron intake was lower among breastfed children, but the bioavailability of this nutrient in breast milk is higher.

O objetivo deste artigo é analisar a associação entre o tipo de aleitamento no primeiro semestre de vida e o consumo de vitamina A e ferro do 6º ao 12º mês. Estudo de coorte com 226 crianças. Avaliou-se o tipo de aleitamento do 1º ao 6º mês de vida e o consumo alimentar do 6º ao 12º mês. O consumo de nutrientes entre os grupos foi comparado pelo teste Kruskal-Wallis. A análise da associação entre o consumo de nutrientes e o tipo de aleitamento se deu pela Regressão de Poisson. O consumo abaixo da recomendação de vitamina A e ferro foi de 33,6% e 67,7%, respectivamente. Crianças amamentadas de maneira exclusiva e predominante no 1º e 2º mês tiveram maior ingestão de vitamina A do 6º ao 12º mês de vida. Já as que estavam em aleitamento materno no 6º mês tiveram maior ingestão de vitamina A e menor de ferro na análise bivariada. O grupo que recebeu aleitamento materno misto e artificial no 1º mês e os não amamentados no 6º mês tiveram consumo de vitamina A abaixo do recomendado do 6º ao 12º mês de vida. Os resultados reforçam a importância do aleitamento materno exclusivo nos seis primeiros meses de vida, contribuindo para o maior consumo de vitamina A. O consumo de ferro foi menor entre as crianças amamentadas, porém, a biodisponibilidade desse nutriente no leite materno é maior.

Family dyslipidemia and associated factors with changes in lipid profile in children. / Dislipidemia familiar e fatores associados a alterações no perfil lipídico em crianças.

This article aimed to assess the prevalence of dyslipidemia and associated factors in children aged from 4 to 7 years old. It is a cross-sectional study conducted with 402 children aged from 4 to 7 years old, accompanied by a Lactation Support Program in the first six months of life. We measured total cholesterol, triglycerides and high-density lipoprotein (HDL) and low-density lipoprotein (LDL). We selected the variables that could be associated with the lipid profile, such as the family history of dyslipidemia, nutritional status and food consumption of children. We performed Poisson regression analysis with robust variance. The level of significance adopted was p<0.05. We observed increased LDL values in 46.8% (188), total cholesterol in 37.6% (151), triglycerides in 10.4% (42) and below-desirable HDL in 33.8% (136) of the children. There was a statistically significant association between the family history of dyslipidemia with total cholesterol, LDL and triglycerides (p<0.05 and p < 0.001, respectively); Early weaning with LDL (p < 0.05); Sedentarism with LDL and triglycerides (p < 0.05 and p < 0.001, respectively); as well as HDL with candy consumption (p < 0.05). There was a significant prevalence of changes in the lipid profile of the children. Nutrition education activities and programs aimed at this group are needed.

O objetivo deste artigo é avaliar a prevalência de dislipidemia e os fatores associados em crianças de 4 a 7 anos de idade. Estudo transversal, realizado com 402 crianças de 4 a 7 anos de idade, acompanhadas por um Programa de Apoio a Lactação nos primeiros seis meses de vida. Foram dosados colesterol total, triglicerídeos e lipoproteínas de alta (HDL) e baixa densidades (LDL). Selecionou-se variáveis que poderiam estar associadas ao perfil lipídico, como o histórico familiar de dislipidemia, estado nutricional e o consumo alimentar das crianças. Realizou-se análise de Regressão de Poisson com variância robusta. O nível de significância adotado foi de p < 0,05. Observou-se valores aumentados da LDL em 46,8% (188), colesterol total em 37,6% (151), triglicerídeos em 10,4% (42) e HDL abaixo do desejável em 33,8% (136) das crianças. Houve associação estatisticamente significativa entre o histórico familiar de dislipidemia com colesterol total, LDL e triglicerídeos (p < 0,05 e p < 0,001, respectivamente); Desmame precoce com LDL (p < 0,05); Sedentarismo com LDL e triglicerídeos (p < 0,05 e p < 0,001, respectivamente); bem como HDL com o consumo de bala (p < 0,05). Houve importante prevalência de alterações no perfil lipídico das crianças. São necessárias atividades de educação nutricional e programas voltados para esse grupo.

Blood pressure is associated with body adiposity indicators in children aged 4 to 7 years. / A pressão arterial está associada a indicadores de adiposidade corporal em crianças de quatro a sete anos.

INTRODUCTION AND OBJECTIVE: Studies in adults have shown an association between increased adiposity and hypertension, but few studies have analyzed this association in childhood. The aim of this study was to investigate the association between blood pressure (BP) and body adiposity indicators in children, controlling for the variables of birth conditions, sociodemographics, lifestyle and diet. METHODS: In this cross-sectional study of 399 children aged 4 to 7 years, the dependent variable was BP, measured according to the protocol established by the 7th Brazilian Guidelines on Hypertension. The explanatory variables of the study were waist-to-height ratio (WHtR) and body mass index (BMI). Multiple linear regression was used to assess the independent association between adiposity and BP indicators adjusted for the variables of birth conditions, sociodemographics, lifestyle and diet. Statistical significance was set as α=5%. RESULTS: BMI for age and WHtR correlated positively with systolic (SBP) and diastolic blood pressure (DBP). After multivariate analysis, higher values of BMI (model 1) and WHtR (model 2) were associated with increased SBP and DBP. CONCLUSION: Increased body adiposity, as assessed by BMI and WHtR, was associated with increased SBP and DBP among the children studied. Thus, we suggest the use of BMI and WHtR in the nutritional assessment of children to detect changes in BP and other cardiometabolic risk factors in this population.

Determinants of the mean growth rate of children under the age of six months: a cohort study. / Determinantes da velocidade média de crescimento de crianças até seis meses de vida: um estudo de coorte.

This study aimed to investigate some factors that contributed to higher or lower growth rate of children up to the sixth month of life. This is a cohort study with 240 children evaluated in four stages. Variables of birth, eating habits of the child, mothers' breast-feeding difficulty and pacifier use were investigated. Children's weight gain rate (grams/day) and size gain (cm/month) were measured in all assessments and compared according to the variables of interest. In the first month, weight gain rate of children born by cesarean section was smaller. By the second month, the growth rate (weight and size gain) was higher among children who were exclusively or predominantly breastfed and lower among those who consumed infant formula. Children of mothers who reported difficulty to breastfeed showed a lower growth rate until the second month. Children age four months who consumed porridge had lower weight and size gain rate. Pacifier use was associated with lower weight gain rates up the first, second and fourth month.

Sociodemographic, perinatal and behavioral factors associated to types of milk consumed by children under in six months: birth coort. / Fatores sociodemográficos, perinatais e comportamentais associados aos tipos de leite consumidos por crianças menores de seis meses: coorte de nascimento.

This study evaluated factors associated with the consumption of breast milk (BM), infant formula (IF) and cow milk (CM) in children. This was a cohort study with 256 children followed-up at the 1st, 4th and 6th month of age in Viçosa (MG), Brazil. With respect to CM and IF, consumption was recorded regardless of BM intake. Regarding BM, only exclusive or predominant consumption was considered. From the 1st to the 6th month, an increase was recorded in the number of children who did not consume BM exclusively or predominantly (31.6%), as well as the consumption of CM (27.2%) and IF (9.3%). BM was associated with pacifier use at 1st month, and mother's employment status and pacifier use in the 4th and 6th month. Pacifier use was a risk factor for IF consumption in every month, while belonging to the lower income group was inversely associated in the 6th month. As for CM, the number of prenatal visits was a risk factor in every month, the mother's employment status and use of pacifier in the 4th month, family income, mother's employment status, low birth weight, number of prenatal visits and pacifier use in the 6th month. Since the 1st month, the introduction of other milk types is high, revealing that there is still much to go to ensure exclusive breastfeeding up to 6 months.

Avaliar os fatores associados ao consumo de leite materno (LM), fórmulas lácteas (FL) e leite de vaca (LV). Estudo de coorte com 247 crianças acompanhadas no 1°, 4° e 6° mês de vida, em Viçosa-MG. Para o LV e FL contabilizouse o consumo independentemente da ingestão de LM. Para o LM, considerou-se apenas o consumo exclusivo ou predominante. Do 1° ao 6° mês observou-se o aumento do não consumo de LM de forma exclusiva ou predominante (31,6%), bem como do consumo de LV (27,2%) e FL (9,3%). O LM associou-se ao uso de chupeta no 1° mês, e ao trabalho materno e uso de chupeta no 4° e 6° mês. O uso de chupeta foi fator de risco para o consumo de FL em todos os meses, enquanto pertencer ao grupo de menor renda foi inversamente associado no 6° mês. Para o LV, o número de consultas pré-natal foi fator de risco em todos os meses, o trabalho materno e o uso de chupeta no 4° mês, a renda familiar, trabalho materno, baixo peso ao nascer, número de consultas pré-natal e uso de chupeta no 6° mês. Desde o 1° mês a introdução de outros tipos de leite é elevada, revelando que ainda há muito a se percorrer para a garantia do aleitamento materno exclusivo até os 6 meses.

[Methods of a posteriori identification of food patterns in Brazilian children: a systematic review]. / Metodologias de identificação de padrões alimentares a posteriori em crianças brasileiras: revisão sistemática.

The objective of this study is to provide guidance for identifying dietary patterns using the a posteriori approach, and analyze the methodological aspects of the studies conducted in Brazil that identified the dietary patterns of children. Articles were selected from the Latin American and Caribbean Literature on Health Sciences, Scientific Electronic Library Online and Pubmed databases. The key words were: Dietary pattern; Food pattern; Principal Components Analysis; Factor analysis; Cluster analysis; Reduced rank regression. We included studies that identified dietary patterns of children using the a posteriori approach. Seven studies published between 2007 and 2014 were selected, six of which were cross-sectional and one cohort, Five studies used the food frequency questionnaire for dietary assessment; one used a 24-hour dietary recall and the other a food list. The method of exploratory approach used in most publications was principal components factor analysis, followed by cluster analysis. The sample size of the studies ranged from 232 to 4231, the values of the Kaiser-Meyer-Olkin test from 0.524 to 0.873, and Cronbach's alpha from 0.51 to 0.69. Few Brazilian studies identified dietary patterns of children using the a posteriori approach and principal components factor analysis was the technique most used.

Metabolic syndrome, insulin resistance and other cardiovascular risk factors in university students.

A cross-sectional population-based study using questionnaire and anthropometric data was conducted on 968 university students of São Luís, Brazil, from which 590 showed up for blood collection. In the statistical analysis the Student t-test, Mann-Whitney and chi-square tests were used. The prevalence of metabolic syndrome by the Joint Interim Statement (JIS) criteria was 20.5%, almost three times more prevalent in men (32.2%) than in women (13.5%) (P < 0.001). The prevalence of insulin resistance was 7.3% and the prevalence of low HDL-cholesterol was high (61.2%), both with no statistically significant differences by sex. Men showed a higher percentage of smoking, overweight, high blood pressure, high blood glucose and increased fasting hypertriglyceridemia. Women were more sedentary. University students of private institutions had higher prevalences of sedentary lifestyle, obesity, abdominal obesity, elevated triglycerides and metabolic syndrome than students from public institutions. High prevalences of metabolic syndrome, insulin resistance and other cardiovascular risk factors were found in this young population. This suggests that the burden of these diseases in the future will be increased.

The association between cardiovascular risk factors and anthropometric obesity indicators in university students in São Luís in the State of Maranhão, Brazil.

The article aims to evaluate the relation between cardiovascular risk factors (CVRF) and anthropometric indicators in a sample of university students from São Luís-MA, Brazil. It is a cross-sectional study conducted with 968 university students, with median age of 22. Glycemia, triglycerides, HDL-c, smoking, alcohol consumption, physical inactivity, metabolic syndrome (Joint Interim Statement criteria) and insulin resistance (IR), were associated and correlated with anthropometric indicators such as BMI, WC, WHR and WHtR. Associations were found between TGL, SH, SM and higher values of all anthropometric variables. The RI was associated with higher BMI values and WHtR in men and women. The low HDL-c was associated with higher values of all anthropometric variables in women. Consumption of alcohol was associated with higher values of BMI and WC in women and WHR in men and WHtR. Smoking was associated with higher values of WHtR in both sexes. Physical inactivity was associated with higher values of WHR in men only. The highest correlations were established for women between TGL and BMI CC, WHR and WHtR. The indicators most associated with CVRF were BMI, WC and WHtR in females and WHR and WHtR in men.

[Food consumption and nutritional adequacy in Brazilian children: a systematic review]. / Consumo alimentar e adequação nutricional em crianças brasileiras: revisão sistemática.

OBJECTIVE: To perform a review of studies of food consumption and nutritional adaptation in Brazilian infants pointing the main findings and limitations of these studies. DATA SOURCE: The articles were selected from Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) (Latin-American and Caribbean Literature in Health Sciences), Scientific Electronic Library Online (SciELO) and Science Direct in Portuguese and in English. The descriptors were: "food consumption", "nutritional requirements", "infant nutrition" and "child". The articles selected were read by two evaluators that decided upon their inclusion. The following were excluded: studies about children with pathologies; studies that approached only food practices or those adaptation of the food groups or the food offert; and studies that did not utilize the Dietary Reference Intakes (DRI). DATA SYNTHESIS: Were selected 16 studies published between 2003 and 2013. In the evaluation of the energy consumption, four studies presented energetic consumption above the individual necessities. The prevalence of micronutrients inadequacy ranged from 0.4% to 65% for iron, from 20% to 59.5% for vitamin A, from 20% to 99.4% for zinc, from 12.6% to 48.9% for calcium and from 9.6% 96.6% for vitamin C. CONCLUSIONS: The food consumption of Brazilian infants is characterized by high frequencies of inadequacy of micronutrients consumption, mainly iron, vitamin A and zinc. These inadequacies do not exist only as deficiencies, but also as excesses, as noted for energetic consumption.

Association of the degree of food processing with the consumption of nutrients and blood pressure / Associação do grau de processamento de alimentoscom o consumo de nutrientes e pressão arterial

There are many causes for hypertension, but among the modifiable factors, inadequate lifestyle is related to the higherprevalence of the disease. Therefore, the objective of this study was to evaluate the association between macro andmicronutrient intake and blood pressure levels with the degree of food processing. Sixty-four adults from the rural areaof Viçosa, Minas Gerais, Brazil were evaluated. Food consumption was assessed by a dietary recall using AVANUTRISoftware, and the foods consumed were classified into three groups: in natura or minimally processed, processed andultra-processed. Blood pressure was measured using an automatic inflation monitor. The data were analyzed in the StataSoftware by means of the Student’s T test. Most of the sample consisted of female adults (64.1%) and the mean systolicand diastolic blood pressure was 122.8 mmHg (±17.1) and 77.7 mmHg (±10.9), respectively. The group of in natura orminimally processed food was responsible for the largest contribution (85.2%) of the average caloric intake (1,793.1 kcal/day), while the consumption of ultra-processed foods was only 7.7%. In addition, there was a higher intake of carbohydrate,lipid, cholesterol, polyunsaturated fat, vitamin E, potassium and sodium among individuals who consumed only in naturaor minimally processed foods. Individuals who did not consume ultra-processed foods had higher intakes of vitamin Eand sodium. It was concluded that there was an association between the degree of food processing and nutrient intake,however, no association was found among blood pressure levels(AU)

São muitos os motivos desencadeadores da hipertensão arterial, mas dentre os fatores modificáveis, o estilo de vidainadequado está relacionado com a maior prevalência da doença. Portanto, objetivou-se avaliar a associação entre aingestão de macro e micronutrientes e os níveis de pressão arterial com o grau de processamento de alimentos. Avaliouse64 adultos da área rural de Viçosa, Minas Gerais. O consumo alimentar foi avaliado pelo recordatório habitualno Software AVANUTRI, e os alimentos consumidos foram classificados em três grupos: in natura ou minimamenteprocessados, processados e ultraprocessados. A pressão arterial foi aferida utilizando monitor de suflação automática. Osdados foram analisados no Software Stata por meio do teste t de student. A maioria da amostra foi constituída por adultosdo sexo feminino (64,1%) e a média da pressão arterial sistólica foi de 122,8 mmHg (±17,1) e da diastólica 77,7 mmHg(±10,9). O grupo de alimentos in natura ou minimamente processados foi o responsável pela maior contribuição (85,2%)do aporte calórico médio (1.793,1 kcal/dia), enquanto que o consumo de alimentos ultraprocessados foi de apenas7,7%. Ainda, houve maior ingestão de carboidrato, lipídio, colesterol, gordura poli-insaturada, vitamina E, potássio esódio entre os indivíduos que consumiram apenas alimentos in natura ou minimamente processados. Já os indivíduosque não consumiram alimentos ultraprocessados apresentaram maior ingestão de vitamina E, e sódio. Conclui-se quehouve associação entre o grau de processamento de alimentos com a ingestão de nutrientes, entretanto a mesma não foiverificada entre os níveis de pressão arterial(AU)

Fatores associados aos padrões alimentares no segundo semestre de vida / Factors associated with dietary patterns in the second half of life

Resumo O objetivo deste artigo é identificar padrões alimentares de crianças com 6, 9 e 12 meses e sua associação com variáveis socioeconômicas, comportamentais, de nascimento e nutrição. Estudo transversal com crianças de uma coorte em Viçosa-MG, sendo 112 crianças com 6 meses, 149 com 9 meses e 117 com 12 meses. O consumo alimentar foi avaliado por um recordatório de 24 horas e os padrões extraídos por análise de agrupamentos. O leite materno foi identificado em pelo menos um padrão alimentar em todos os meses. Houve baixa participação de alimentos ultraprocessados nos padrões alimentares identificados. No 6º mês, crianças com menor renda familiar tiveram menos chance de pertencer ao padrão alimentar composto por fórmulas lácteas. Já o sobrepeso/obesidade foi 3,69 vezes maior em crianças que compunham o padrão 2 (fórmulas lácteas, verduras, legumes, carne bovina e pera). Aos 12 meses o déficit de estatura (RP = 3,28) e o uso de mamadeira (RP = 4,51) estiveram associados ao padrão alimentar composto por fórmulas lácteas e leite de vaca. Os padrões alimentares identificados refletiram a importante participação do leite materno na alimentação das crianças. Padrões alimentares com a presença de outros tipos de leite, foram associados a desvios nutricionais e uso de mamadeiras.

Abstract The aim of this paper is to identify eating patterns of children aged 6, 9 and 12 months and their association with socioeconomic, behavioral, birth and nutrition variables. Cross-sectional study with children from a cohort in Viçosa-MG, with 112 children at 6 months, 149 at 9 months and 117 at 12 months. Food intake was assessed by a 24-hour recall and patterns extracted by cluster analysis. Breast milk was identified in at least one dietary pattern every month. There was a low participation of ultra-processed foods in the identified dietary patterns. At month 6, children with lower family income were less likely to belong to the dietary pattern composed of milk formulas. Already overweight/obesity was 3.69 times higher in children who made up the pattern 2 (dairy formulas, vegetables, vegetables, beef and pear). At 12 months height deficit (PR = 3.28) and bottle use (PR = 4.51) were associated with the dietary pattern composed of milk formulas and cow's milk. The dietary patterns identified reflected the important participation of breast milk in children's diets. Dietary patterns with the presence of other types of milk were associated with nutritional deviations and bottle feeding.

Dislipidemia familiar e fatores associados a alterações no perfil lipídico em crianças / Family dyslipidemia and associated factors with changes in lipid profile in children

Resumo O objetivo deste artigo é avaliar a prevalência de dislipidemia e os fatores associados em crianças de 4 a 7 anos de idade. Estudo transversal, realizado com 402 crianças de 4 a 7 anos de idade, acompanhadas por um Programa de Apoio a Lactação nos primeiros seis meses de vida. Foram dosados colesterol total, triglicerídeos e lipoproteínas de alta (HDL) e baixa densidades (LDL). Selecionou-se variáveis que poderiam estar associadas ao perfil lipídico, como o histórico familiar de dislipidemia, estado nutricional e o consumo alimentar das crianças. Realizou-se análise de Regressão de Poisson com variância robusta. O nível de significância adotado foi de p < 0,05. Observou-se valores aumentados da LDL em 46,8% (188), colesterol total em 37,6% (151), triglicerídeos em 10,4% (42) e HDL abaixo do desejável em 33,8% (136) das crianças. Houve associação estatisticamente significativa entre o histórico familiar de dislipidemia com colesterol total, LDL e triglicerídeos (p < 0,05 e p < 0,001, respectivamente); Desmame precoce com LDL (p < 0,05); Sedentarismo com LDL e triglicerídeos (p < 0,05 e p < 0,001, respectivamente); bem como HDL com o consumo de bala (p < 0,05). Houve importante prevalência de alterações no perfil lipídico das crianças. São necessárias atividades de educação nutricional e programas voltados para esse grupo.

Abstract This article aimed to assess the prevalence of dyslipidemia and associated factors in children aged from 4 to 7 years old. It is a cross-sectional study conducted with 402 children aged from 4 to 7 years old, accompanied by a Lactation Support Program in the first six months of life. We measured total cholesterol, triglycerides and high-density lipoprotein (HDL) and low-density lipoprotein (LDL). We selected the variables that could be associated with the lipid profile, such as the family history of dyslipidemia, nutritional status and food consumption of children. We performed Poisson regression analysis with robust variance. The level of significance adopted was p<0.05. We observed increased LDL values in 46.8% (188), total cholesterol in 37.6% (151), triglycerides in 10.4% (42) and below-desirable HDL in 33.8% (136) of the children. There was a statistically significant association between the family history of dyslipidemia with total cholesterol, LDL and triglycerides (p<0.05 and p < 0.001, respectively); Early weaning with LDL (p < 0.05); Sedentarism with LDL and triglycerides (p < 0.05 and p < 0.001, respectively); as well as HDL with candy consumption (p < 0.05). There was a significant prevalence of changes in the lipid profile of the children. Nutrition education activities and programs aimed at this group are needed.

Association of the degree of food processing with the consumption of nutrients and blood pressure / Associação do grau de processamento de alimentoscom o consumo de nutrientes e pressão arterial

There are many causes for hypertension, but among the modifiable factors, inadequate lifestyle is related to the higherprevalence of the disease. Therefore, the objective of this study was to evaluate the association between macro andmicronutrient intake and blood pressure levels with the degree of food processing. Sixty-four adults from the rural areaof Viçosa, Minas Gerais, Brazil were evaluated. Food consumption was assessed by a dietary recall using AVANUTRISoftware, and the foods consumed were classified into three groups: in natura or minimally processed, processed andultra-processed. Blood pressure was measured using an automatic inflation monitor. The data were analyzed in the StataSoftware by means of the Student’s T test. Most of the sample consisted of female adults (64.1%) and the mean systolicand diastolic blood pressure was 122.8 mmHg (±17.1) and 77.7 mmHg (±10.9), respectively. The group of in natura orminimally processed food was responsible for the largest contribution (85.2%) of the average caloric intake (1,793.1 kcal/day), while the consumption of ultra-processed foods was only 7.7%. In addition, there was a higher intake of carbohydrate,lipid, cholesterol, polyunsaturated fat, vitamin E, potassium and sodium among individuals who consumed only in naturaor minimally processed foods. Individuals who did not consume ultra-processed foods had higher intakes of vitamin Eand sodium. It was concluded that there was an association between the degree of food processing and nutrient intake,however, no association was found among blood pressure levels

São muitos os motivos desencadeadores da hipertensão arterial, mas dentre os fatores modificáveis, o estilo de vidainadequado está relacionado com a maior prevalência da doença. Portanto, objetivou-se avaliar a associação entre aingestão de macro e micronutrientes e os níveis de pressão arterial com o grau de processamento de alimentos. Avaliouse64 adultos da área rural de Viçosa, Minas Gerais. O consumo alimentar foi avaliado pelo recordatório habitualno Software AVANUTRI, e os alimentos consumidos foram classificados em três grupos: in natura ou minimamenteprocessados, processados e ultraprocessados. A pressão arterial foi aferida utilizando monitor de suflação automática. Osdados foram analisados no Software Stata por meio do teste t de student. A maioria da amostra foi constituída por adultosdo sexo feminino (64,1%) e a média da pressão arterial sistólica foi de 122,8 mmHg (±17,1) e da diastólica 77,7 mmHg(±10,9). O grupo de alimentos in natura ou minimamente processados foi o responsável pela maior contribuição (85,2%)do aporte calórico médio (1.793,1 kcal/dia), enquanto que o consumo de alimentos ultraprocessados foi de apenas7,7%. Ainda, houve maior ingestão de carboidrato, lipídio, colesterol, gordura poli-insaturada, vitamina E, potássio esódio entre os indivíduos que consumiram apenas alimentos in natura ou minimamente processados. Já os indivíduosque não consumiram alimentos ultraprocessados apresentaram maior ingestão de vitamina E, e sódio. Conclui-se quehouve associação entre o grau de processamento de alimentos com a ingestão de nutrientes, entretanto a mesma não foiverificada entre os níveis de pressão arterial

Relação entre os tipos de aleitamento materno e o consumo de vitamina A e ferro em crianças de 6 a 12 meses / Relationship between breastfeeding patterns and intake of vitamin A and iron in children 6-12 months

Resumo O objetivo deste artigo é analisar a associação entre o tipo de aleitamento no primeiro semestre de vida e o consumo de vitamina A e ferro do 6º ao 12º mês. Estudo de coorte com 226 crianças. Avaliou-se o tipo de aleitamento do 1º ao 6º mês de vida e o consumo alimentar do 6º ao 12º mês. O consumo de nutrientes entre os grupos foi comparado pelo teste Kruskal-Wallis. A análise da associação entre o consumo de nutrientes e o tipo de aleitamento se deu pela Regressão de Poisson. O consumo abaixo da recomendação de vitamina A e ferro foi de 33,6% e 67,7%, respectivamente. Crianças amamentadas de maneira exclusiva e predominante no 1º e 2º mês tiveram maior ingestão de vitamina A do 6º ao 12º mês de vida. Já as que estavam em aleitamento materno no 6º mês tiveram maior ingestão de vitamina A e menor de ferro na análise bivariada. O grupo que recebeu aleitamento materno misto e artificial no 1º mês e os não amamentados no 6º mês tiveram consumo de vitamina A abaixo do recomendado do 6º ao 12º mês de vida. Os resultados reforçam a importância do aleitamento materno exclusivo nos seis primeiros meses de vida, contribuindo para o maior consumo de vitamina A. O consumo de ferro foi menor entre as crianças amamentadas, porém, a biodisponibilidade desse nutriente no leite materno é maior.

Abstract The aim of this study was to analyze the association between breastfeeding type in the first six months of life and intake of vitamin A and iron in children 6-12 months of age. It is a cohort study with 226 children. The type of breastfeeding from 1-6 months of life and the food intake from 6 to 12 months were evaluated. Nutrient intake between groups was compared by the Kruskal-Wallis test. The association between nutrient intake and type of breastfeeding was analyzed by Poisson Regression. Consumption below the recommendation of vitamin A and iron was 33.6% and 67.7%, respectively. Infants exclusively and predominantly breastfed from birth to two months had higher vitamin A intake from 6-12 months of life. Infants who were breastfeeding at 6 months had higher vitamin A intake and lower iron by the bivariate analysis. The group that received mixed feeding and artificial feeding at 1 month and the group non-breastfed at 6 months had vitamin A intake below the recommended from 6-12 month of life. The results reinforce the importance of exclusive breastfeeding in the first six months of life contributing to the higher vitamin A intake. Iron intake was lower among breastfed children, but the bioavailability of this nutrient in breast milk is higher.

Neural complications and physical disabilities in leprosy in a capital of northeastern Brazil with high endemicity.

INTRODUCTION: Leprosy is an infectious disease whose etiologic agent is Mycobacterium leprae, manifested by dermatological and neurological signs and symptoms. OBJECTIVE: To investigate neural changes and the degree of physical disability in the eyes, hands and feet before and after treatment, as well as sociodemographic and clinical profile of patients affected by leprosy. METHOD: A longitudinal epidemiological study comprising 155 patients with leprosy, from a spontaneous demand, diagnosed between March 2010 and February 2011, and treated with multidrug therapy (MDT) between March 2010 and July 2012 in a program for leprosy eradication in São Luis (MA), Brazil. RESULTS: Before treatment, 46.5% of patients were considered as borderline, 51.6% had some alteration in the eyes and 52.3% in the feet, and the radial nerve (18.7%) was the most affected. There was a statistically significant difference between the changes in the radial nerve at the beginning of and after treatment. CONCLUSIONS: The analysis points to late diagnosis, as some patients have had abnormal neural and physical disabilities before treatment.

Markers of healthy eating habits, water intake, and constipation in children between 4 and 7 years of age / Marcadores de alimentação saudável, ingestão de água e constipação intestinal em crianças de 4 a 7 anos de idade

ABSTRACT Objective To evaluate the association between diet and constipation in children between four and seven years of age. Methods A cross-sectional study with 152 children between 4 and 7 years of age residing in Viçosa, Brazil. Constipation was defined in accordance with the Rome IV diagnostic criteria. Dietary habits were evaluated based on the frequency of food intake using a food diary for three days. Dietary analysis considered foods deemed healthy and unhealthy which could be associated with constipation, as well as the children's consumption of fruits and vegetables. The amounts of fiber and water consumed were also rated as adequate or inadequate. As part of the analyses, Student's t-test and the chi-square test were performed with a significance level of p<0.05. Results The prevalence of constipation was 32.2%. Constipation was more common among children who did not consume fruits (p=0.020) or greens (p=0.002), as well as among children who consumed "instant" chocolate drinks (p=0.033). An association was found between the frequent consumption of fried food (p=0.020), a daily water intake lower than 600mL, and constipation (p=0.028). Conclusion Unhealthy eating habits among children, such as the lack of fruit and greens intake and the consumption of "instant" chocolate drinks and fried foods, were found to be positively correlated with constipation. The low fruit and vegetable consumption observed herein reflects the need for changes in children's eating habits and the implementation of measures to promote the intake of healthy foods.

RESUMO Objetivo O estudo visa avaliar a associação do consumo alimentar de crianças de quatro a sete anos de idade com constipação intestinal. Métodos Foi realizado estudo transversal com 152 crianças de 4 a 7 anos, residentes em Viçosa, Minas Gerais, Brasil. A constipação intestinal foi identificada de acordo com os critérios de Roma IV. Avaliou-se o consumo alimentar por meio da frequência de consumo de alimentos e do registro alimentar de três dias. Na análise do consumo alimentar selecionaram-se os alimentos marcadores de alimentação saudável e não saudável que poderiam estar associados à constipação, além do consumo agrupado de frutas, verduras e legumes. Verificou-se ainda adequação do consumo de fibras e ingestão de água. Nas análises, foram realizados os testes t-Student e qui-quadrado, considerando-se como significância estatística p<0,05. Resultados A prevalência de constipação foi de 32,2%, sendo maior entre as crianças que não consumiam frutas (p=0,020) e verduras (p=0,002) e consumiam achocolatados (p=0,033). Houve associação entre a constipação (p=0,028) e o consumo frequente de frituras (p=0,020), ingestão diária de água inferior a 600mL. Conclusão Hábitos não saudáveis das crianças, como a baixa ingestão de frutas e verduras, e o consumo de achocolatado e frituras, contribuíram para a associação positiva com a constipação. O baixo consumo de frutas, verduras e legumes revela a necessidade de alteração dos hábitos alimentares das crianças, bem como da implantação de ações para incentivo ao consumo de alimentos saudáveis.

Consumo de ultraprocessados e estado nutricional de crianças com transtorno do espectro do autismo / Consumo de ultraprocesados y estado nutricional de niños con trastorno del espectro autista / Consumption of ultra-processed foods and nutritional status of children with autism spectrum disorder

OBJETIVO: Analisar o consumo de alimentos ultraprocessados entre crianças com transtorno do espectro do autismo (TEA) e sua associação com o estado nutricional. MÉTODOS: Realizou-se um estudo transversal, em São Luís, Maranhão, Brasil, com amostra de 29 crianças, em 2017. Utilizou-se um questionário semiestruturado, aplicado aos pais ou responsáveis, para obtenção de variáveis sociodemográficas. O estado nutricional foi avaliado pelos indicadores de índice de massa corporal/idade e estatura/idade. Obteve-se o consumo alimentar por meio de recordatório de 24h, a partir do qual foi calculado o percentual de contribuição calórica e a média dos alimentos consumidos de acordo com o nível de processamento. Para comparação do consumo dos ultraprocessados de acordo com o estado nutricional, utilizou-se o teste t de Student, com nível de significância de 5%. RESULTADOS: Verificou-se o excesso de peso em 55,2% (n=16) das crianças e o consumo de alimentos ultraprocessados foi responsável por 28% (560 kcal/dia) da contribuição calórica. Crianças com excesso de peso consumiram maior média percentual de alimentos ultraprocessados do que as sem excesso de peso (34,2% versus 19,4%, p=0,009). O consumo de frutas representou apenas 4,3% (74,6 kcal) da contribuição calórica total, e as hortaliças foram os alimentos in natura menos consumidos pelas crianças. CONCLUSÃO: Alimentos in natura ou minimamente processados foram a base da alimentação das crianças estudadas. Apesar disso, o maior consumo de alimentos ultraprocessados foi associado ao excesso de peso nas crianças com TEA. (AU)

OBJECTIVE: To analyze the consumption of ultra-processed foods among children with autism spectrum disorder (ASD) and its association with nutritional status. METHODS: Cross-sectional study of 29 children conducted in 2017 in São Luís, Maranhão, Brazil. A semistructured questionnaire was used with parents or caregivers to obtain sociodemographic information. The nutritional status was assessed based on body mass index/age and height/age. The food consumption was assessed using a 24h recall, which was used to estimate the percentage of caloric contribution and the mean of the foods consumed according to the level of processing. Student's t test with a significance level of 5% was used to compare the consumption of ultra-processed foods in relation to the nutritional status. RESULTS: Overweight was observed in 55.2% (n=16) of the children and the consumption of ultra-processed foods was responsible for 28% (560 kcal/day) of caloric contribution. Overweight children consumed a higher mean percentage of ultra-processed foods than those who were not overweight (34.2% vs. 19.4%, p=0.009). Fruit consumption represented only 4.3% (74.6 kcal) of total caloric contribution and vegetables were the least consumed whole foods among children. CONCLUSION: Whole foods or minimally processed foods were the most consumed food among the analyzed children. However, the higher consumption of ultra-processed foods was associated with overweight in children with ASD. (AU)

OBJETIVO: Analizar el consumo de alimentos ultraprocesados entre los niños con trastorno del espectro autista (TEA) y su asociación con el estado nutricional. MÉTODOS: Se realizó un estudio transversal, en São Luís, Maranhão, Brasil, con una muestra de 29 niños en 2017. Se utilizó un cuestionario semi-estructurado que ha sido aplicado a los padres o responsables para obtener las variables sociodemográficas. El estado nutricional ha sido evaluado por los indicadores del índice de masa corporal/edad y estatura/edad. Se obtuvo el consumo alimentario a través del recordatorio de 24 horas del cual ha sido calculado el porcentaje de la contribución calórica y la media de los alimentos consumidos según el nivel de procesamiento. Para comparar el consumo de los ultraprocesados según el estado nutricional se utilizó la prueba t de Student con el nivel de significación del 5%. RESULTADOS: Se verificó el exceso de peso en el 55,2% (n=16) de los niños y el consumo de alimentos ultraprocesados ha sido responsable por el 28% (560 kcal/día) de la contribución calórica. Niños con exceso de peso han consumido la mayor media percentual de alimentos ultraprocesados que los sin el exceso de peso (34,2% versus 19,4%, p=0,009). El consumo de frutas ha representado solamente el 4,3% (74,6 kcal) de la contribución calórica total y las hortalizas han sido los alimentos in natura menos consumidos por los niños. CONCLUSIÓN: Alimentos in natura o los muy poco procesados fueron la base de la alimentación de los niños estudiados. Sin embargo, el mayor consumo de alimentos ultraprocesados se asoció con el exceso de peso de los niños con TEA. (AU)